Constipation frustration

One of my cats (Klio) has chronic constipation related to being on fluoxetine. Off of it, she's fine in the poo department, but has horrible mood swings and all the other psych medications we tried either made her worse, or had much worse side effects (like making her "drunk" and sedated). None of the herbal or homeopathic remedies we tried did much, and behavior modification only works when she's on it. Her vet has run a full panel of tests twice, done X-rays, etc., and can find absolutely nothing physically wrong with her.

So basically, on the fluoxetine she is constipated, and off of it she's miserable and violent, so we've been keeping her on it.

But I really struggle to keep on top of her constipation. She's on Miralax, 1/8 teaspoon twice a day. She eats mainly wet food (venison-based, generally Natural Balance Venison LID, which is 1% fiber, since that's what my IBD cat eats - I add water), but if her appetite is low (another side effect that comes and goes), she gets Wellness original formula dry - maybe 1/4 cup once or twice a week. This was recommended by her vet, who wants her on a low residue diet, after she was on a high fiber diet and nearly ended up with megacolon. I would prefer not to give her dry food at all, but it seems to "boost" her appetite (whenever she starts picking at her wet food and losing interest, I'll give her a little dry and her appetite for everything picks back up a lot). She also gets a dose of a B-complex vitamin twice a day, because she was having problems with that.

She'll go weeks seeming to be fine, and then just have an "attack" where she'll go 2-3 days without much or any #2 and be obviously uncomfortable. The most recent was nearly six days with only minimal poop. I gave her Laxatone at first, because she was straining but passing small amounts of hard stool, and that has usually worked before. I was going to bring her in tomorrow because she was looking a bit bloated over the weekend and kept hiding behind the TV (I had planned to take her to the kitty ER if she went more than 18 hours or so without passing anything), but she finally went a lot about six hours ago and already looks less bloated and more comfortable.

I don't really know what to do at this point, although I am still going to talk to her vet about canned pumpkin and other things to do besides the Miralax. I mostly just wanted to vent around people who will understand, lol. But maybe you guys have some other suggestions?

Peppermint, I went through this exact problem with my cats when they were on fluoxentine from November to June.  One cat eventually stabilized with going every other day but the other would only go every 5 days (large deposits).  I also used miralax, hairball gel, and all the other non-spasmodic type of laxatives.  I even used suppositories when possible. I found while these types of aids were helpful in making the passages easier--they did nothing in terms of making my cats go more OFTEN.   

What worked in increasing the frequency of bowel movements:

1) Decrease the dosage of fluoxentine.  My cat who was going every other day functioned on 2.5mg of fluoxetine initially.  Her sister, who was going every 5 days, had to have 5mg to function.  They were still fairly okay when we stepped down to 1.6mg and 3.3mg.

2) Decrease the frequency of fluoxentine dosing.  I dosed my cats every other day rather than every day.  Towards the end as I started to taper them off, I was dosing them every 3rd day.  You may want to find the lowest dosage where your cat will function at every other day or every 3rd day.  Giving her days off from fluoxentine gives her digestion system work.  My vet's initial prescription of 5mg daily was too severe and resulted in instantaneous constipation.

3) The above worked for the cat who had the low dosage of fluoxentine.  Again, she eventually stabilized at an acceptable every other day routine.  It didn't do much for the cat who needed a higher dose of fluoxentine.  Eventually my vet agreed to a SHORT-Term prescription of Cisapride.  The logic was that there wasn't really anything physically wrong with her but she just needed a jump-start to her digestive system after the turmoil and stress of being on fluoxentine and the events that necessitated her being on the drug.  She received one dosing of 5mg Cisapride daily for 20 days.  That was it.  It took a few days to kick in.  But she started going every 3 days.  And AFTER the 20 days of Cisapride, she started going every other day.  I think it also helped that by that point, I was tapering off her fluoxentine.

For your situation, YMMV since it sounds like you cat needs to be on fluoxentine indefinitely.  But perhaps with a combination of changes, she can stabilized at an acceptable BM routine. I know how frustrating the situation can be.  The cycle of being overjoyed when the cat finally has  BM only to be replaced by anxiety as the non-BM days tick by was agonizing.  

My cats are no longer on fluoxentine and their BM schedule is down to about every 36 hours or so.  I'd love for them to go daily on the dot but I'm relieved to see that the constipation problems they had for about 6 months does not seem to have been permanent.  

My other recommendation is that you may want to switch your cat to something beside fluoxentine.  She may be able benefit from another mood drug that doesn't come with the constipation side effect.  By the way, one of the vets at the office told me constipation wasn't a side effect of fluoxentine.  Idiot.

Rereading your post, I see that you have already tried other mood drugs.  I also noticed you feed venison.  It's a long shot but you may want to try another protein to see if it helps.  My cats are constipated straightaway as soon as they eat any type of red meat (that is if they haven't vomited after eating it).  So you may want to eliminate or at least rotate red meat feedings.

Also I found that pumpkin and grass are helpful in forming poop and for very mild forms of constipation but may also slow down the digestive system.  And that those types of fibers weren't helpful in severe constipation cases where cats aren't going for 4-6 days.  No matter the benefits of those items, the last thing you want is to slow down the flow even further.  Google soluble versus insoluble fibers.

tdonline, thank you so much for the suggestions! I will pick up some turkey food (she loves turkey) and try feeding her away from the others for a few weeks to see if that helps. She was doing alright when they were all eating duck, but they all started refusing to eat the duck and I switched. I hadn't even thought about that being one of the problems, but the timing matches up with her "attacks" getting longer/worse.

We have her on three days a week at 2.5mg right now. Going much lower starts to lead to problems, but I will try every three days instead and see if she's still mostly stable on that. I will also ask my vet about Cisapride in emergencies — this last attack was awful, and I don't want to put her (or me) through that again.

She does seem to fine when she has access to cat grass, so maybe I will try to grow my own so it can be a permanent presence instead of a "whenever the pet store has it" treat and see if it helps at all, if the vet okays it. Her normal vet is in the office tomorrow, so I will call then and see what she says and if she wants to see her.

Thank you again so much for your advice. (As for the fluoxetine side effect, Klio's vet said that it wasn't in the literature at all, only diarrhea, but she suspected it was a common side effect because two other cats she was treating had the same problem. So maybe that vet was just inexperienced and didn't know when to keep silent.)

So one of my cats, Kona, has battled chronic constipation forever - a Maine Coon mix with the annoying hangers-on and hairballs to boot. I recently introduced commercial raw food due to intermittent diarrhea with another cat, and I was really pleased with his turnaround. I tried Nature's Variety Instinct Raw Bites - lamb (at the time it was still being made for cats). It totally stabilized the diarrhea....

Fast forward two months and I have all four cats on the Raw Bites 50% of the time. Along with the cat varieties (chicken, duck, turkey) I continue to buy the lamb for dogs and I add taurine (the only difference in the formula). It took a little while to get her to eat it, but sprinkling it with freeze dried meat and liver or Fortiflora helped. Now she cleans her plate and her constipation is greatly reduced. Her mood is better, too. It is early on yet, but I think there is really something to the whole raw idea.... I still add dehydrated and reconstituted pumpkin to her canned (some of the time) and that may be helping as well.

Primal makes a turkey version - don't know why NV doesn't. Also if you go this route, get ready for the poop to change in general - less waste so less stinky and maybe every other day - but it's good poop, ya know? Not all stringy and extruded.... nuff said.

PeppermintPlant said:

 
she gets Wellness original formula dry - maybe 1/4 cup once or twice a week. This was recommended by her vet, who wants her on a low residue diet, after she was on a high fiber diet and nearly ended up with megacolon. I would prefer not to give her dry food at all, but it seems to "boost" her appetite (whenever she starts picking at her wet food and losing interest, I'll give her a little dry and her appetite for everything picks back up a lot). She also gets a dose of a B-complex vitamin twice a day, because she was having problems with that.

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Oh, just noticed that.  My cats also get constipated on grain-free dry food.  They do well on grain free can but gf kibble stuffs them up immediately.  It doesn't sound like your cat eats much dry anyway but it may be a factor in her constipation.  I switched to CA Balance limited ingredients chicken and rice kibble.  It has grain, but I figure going with rice is better than corn or wheat.  My cats get about 1-2 tablespoons of kibble daily.  When I travel, it increases to about 1/4 cup.

tdonline said:

 
Oh, just noticed that.  My cats also get constipated on grain-free dry food.  They do well on grain free can but gf kibble stuffs them up immediately.  It doesn't sound like your cat eats much dry anyway but it may be a factor in her constipation.  I switched to CA Balance limited ingredients chicken and rice kibble.  It has grain, but I figure going with rice is better than corn or wheat.  My cats get about 1-2 tablespoons of kibble daily.  When I travel, it increases to about 1/4 cup.

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Oh, good to know. The vet had suggested a low fiber dry, but I will see if I can find something with rice like you suggested. I did order a grain-free turkey wet food to try; if she eats that well, I won't even give her the dry for a while.

She went again a good amount today, so hopefully things are moving again.

PeppermintPlant said:

She went again a good amount today, so hopefully things are moving again.

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That's great news.  My cats weaned off fluoxentine over a month ago but I still monitor their BM schedule religiously.  It's such a difficult issue--it's hard to relax.

My last piece of advice, which I don't always follow myself as you're desperate to help the furballs go--eliminate/add one step at a time so you know what is and isn't working.